This is the name given to an injection into the small linking joints of the spine, the Facet joints.

This type of treatment is widely used for the treatment of chronic back pain due to Facet Joint disease. A Facet joint injection is not a cure for the cause of your pain, but it is used to help reduce the level of your pain.

Why are you getting it?

Your X Ray or scan has shown that some of your Facet joints are arthritic. Many people have some degree of arthritis in their Facet joints once they get over the age of 30, and why some people should experience pain and others not, is still a bit of a mystery. Some patients do benefit from injections of steroids into their Facet joints. And the only way of finding out if this is the case for you is by trying it.

How does it work?

The injection contains a mixture of local anaesthetic and steroid. It is thought to have the following beneficial effects:

Local anaesthetics numb the nerves for a period of hours giving short-term relief.

Local steroid has a long-term effect reducing inflammation in the joint and around the nerves.

There are only minimal effects on the rest of the body using local steroids by this route of administration. Any side effects, are more likely to occur if steroids are given orally over a short period of time, for example raised blood pressure and weight gain. Diabetics may experience short-term problems.

If the Facet Joint injection is helpful it may be repeated at intervals of a minimum of four months.

What does the treatment involve?

A Facet joint injection is performed as a day case procedure and it is performed with X-Ray control to help identify the small joints accurately.

Shortly before the injection you will need to change into a hospital gown.

You will need to lie face down on the table throughout the procedure. If you have any difficulty in getting into this position a member of staff will be there to help you. Your back will be cleaned with antiseptic and a local anaesthetic injected into the skin to numb the area, there may be some discomfort at the time of the injection. Several joints may be injected in the same session. You will have a small dressing on your back to cover the procedure site. This may be removed after 24 hours but do not worry if it should fall off sooner.

Following the injection you may sleep in any position that you find comfortable

What are the side effects?

You may feel as though your back is a little bruised after the injection and you may also experience an increase in the level of your pain for a few days, this is normal. It will quickly resolve and you can continue to take your normal analgesia for pain.

A small percentage of patients may experience an increased level of pain for much longer.

It is important that you have a responsible adult to escort you home and if possible to stay with you overnight. You must not drive or use public transport for the journey home. It is recommended that you rest for the remainder of the day.

If the Facet joint injection helps to reduce the level of your pain, please remember you will still have a problem with your back. Do not rush about doing strenuous activities, but build up your activity levels slowly.

Potential side effects with use of steroids

There are very few side effects associated with single or occasional use of steroid injections. Hot flushes, feeling sick or having mild abdominal pain are sometimes felt. Control of diabetes may be difficult, and menstrual irregularities may occur. These settle in a few days.

Repeated and frequent use has the potential to lead to more serious side effects, but it must be kept in mind that the dose that is used in the injection is very small compared to those taking steroids by mouth on a daily basis for conditions such as, asthma or arthritis. In those circumstances, side effects such as increase in appetite, weight gain, thinning of the bones (osteoporosis), thinning of the skin, eye problems (glaucoma, cataract), weakness, depression, rounded face, high blood pressure and water retention have been seen. Oral contraceptive pills may increase the level of steroids in the blood.

Additional information and other important points

You will be required to stay in hospital for at least two to three hours following the procedure

If there is excessive or persisting numbness, you may be required to stay in hospital overnight.

A follow up appointment will be arranged, so that the doctor or nurse can review the effects of the Facet joint injection.

You should carry on with your normal activities, increasing them if possible and aim to reduce your painkillers if the effects of the injection appears to be successful

If there are any concerns or queries please contact the pain clinic

It is very important that you inform the doctor or secretary in the pain clinic, at least a week before the injection, if:

You are allergic to any medications

You are on blood thinning medication such as Warfarin, Nicoumalone (Sinthrome), Aspirin, Clopidogrel (Plavix), Ticlopidine (Ticlid).

If you have an infection near the injection site.

If you have had a recent steroid or cortisone injection in the hospital or in your doctors surgery.

If you think you might be pregnant.

If you are diabetic on insulin. Your blood sugar may be difficult to control for a few days, tending to be high.

Caution should be exercised if you have had a recent heart attack or vaccination. Please inform the pain clinic